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Clean vs. sterile tracheotomy care and level of pulmonary infection.

As reported in the literature and observed in clinical practice, a variety of tracheotomy care procedures (tracheotomy suctioning and cleaning techniques) are currently used. The purpose of this research was to determine if clean tracheotomy care was more effective than sterile as measured by levels of postoperative pulmonary infection. Ten hospitals with large Head and Neck/ENT services were selected as data collection sites. At these centers a minimum of 15 tracheostomy patient charts were reviewed pre- and postoperatively for clinical and laboratory data related to infection. Patient level of infection was defined using the Weighted Level of Pulmonary Infection Tool, which was constructed for this study. Three categories of aseptic type emerged (clean, sterile, and mixed) because existing tracheotomy care procedures did not fall into one of the two hypothesized types. Data were analyzed using a maximum likelihood approach to mixed model analysis of variance or covariance. The findings indicated significant differences among the three procedures with laboratory, but not clinical, data. Laboratory data supported practicing clean procedures as those associated with the least postoperative infection.

Analysis of Variance↗
PubMed1983

Control of the aseptic processing environment.

Methods used by industry with applications to hospital pharmacy for maintaining an aseptic environment in production of sterile pharmaceutical products are discussed. A major source of product contamination is airborne microorganisms. The laminar-airflow workbench with a high-efficiency particulate air filter provides an ultraclean environment for preparation of sterile products. However, the workbench does not guarantee sterility of products and is not effective if not properly installed and maintained or if the operator uses poor aseptic technique. The laminar-airflow workbench should be tested for leaks, airflow velocity, and airflow patterns when installed, and the workbench should be checked periodically thereafter. The workbench should be placed in a cleanroom where traffic and air disturbances that might affect the laminar airflow are eliminated. A major source of airborne microbial contamination in cleanrooms is people. Personnel movement through an area and presence of personnel without lint-free, nonshedding protective garments increase the levels of microbial contaminants in an area. The transport of nonsterile products (bottles, boxes, paper products) into a cleanroom should be minimized. The cleanroom itself should be sanitized and should be immaculate. Microbial or particulate monitoring should be conducted in the cleanroom using a quantitative method, and corrective-action limits should be set. Hospital pharmacists should examine industrial sterile-processing techniques and apply them to the preparation of sterile products.

Air Microbiology↗